Is dangerousness an issue for physicians in emergency commitment? The laws of many of the states require a physician to determine that a mentally ill individual presents a danger to others before the disturbed person can be civilly committed for involuntary treatment. The author contends that the prediction of dangerousness is not and should not be within the competence of medicine, but that physicians are competent to judge whether or not the severity of mental illness impairs a patient's competence to make an informed decision regarding treatment. The basic issue in emergency commitment is the patient's welfare, not his potential dangerousness. Dr. Alan A. Stone comments on Dr. Peszke's presentation.


A problem-oriented system approach to analysis of treatment outcome. Data on 90 psychiatric patients' perceptions of the course and outcome of hospitalization were gathered using a problem-oriented system. Patients were interviewed on admission, at discharge, and at two follow-up intervals. Therapists perceptions of patients' problems and their severity were also assessed on patients' admission and at discharge. Although the absolute number of problems reported by patients increased over time, there was a significant decrease over time, there was a significant decrease in the level of distress associated with problems on both patients' and therapists' ratings. The dynamics of this improvement are discussed from the perspectives of both patients and therapists.


Criteria for psychiatric hospitalization: experience with a checklist for chart review. The authors report their experience with a 12-item checklist used to score need for hospitalization. The checklist was filled in and scored by research assistants who reviewed the charts of 100 hospitalized and 50 nonhospitalized patients. A written opinion of a senior clinical consultant was available for hospitalized patients whose charts were rated low in need for hospitalization and for nonhospitalized patients whose charts were rated high. The checklist scores differentiated the two groups of patients. The authors can conclude that the checklist can be a valuable tool in a review process that culminates in review by an experienced clinician.


Utilization review of treatment of suicide attempters: chart review as patient care evaluation. The authors reviewed the charts of 36 nonhospitalized suicide attempters who were identified by utilization review as requiring hospitalization. In 16 of the cases, the authors judged the treatment given to have been adequate because of an absence of a history of psychiatric treatment and/or the rapidity with which outpatient treatment was instiituted. Ten of the cases were judged to have been inadequately treated. This finding pointed to have been inadequately treated. This finding pointed to specific deficiencies in the training of residents and the delivery of psychiatric services and illustrates how chart review can be used to upgrade psychiatric care.


A guide to the use of Procedural Terminology for Psychiatrists. The author emphasizes the potential benefits to patients, physicians, and third-party payers from systematic specification of services rendered by psychiatrists in direct patient care. Procedural Terminology for Psychiatrists provides a reporting system that appropriately reflects variations in skill, complexity, and levels of patient care services. The author suggest that reporting on the basis of specific procedures is an essential aspect in assuring quality care.


Comprehensive sex therapy training: a new approach. The authors have developed a two-year part-time sex therapy training program for physicians. The first year emphasizes instruction in human sexuality as it relations to dysfunctional states. A highly selected group continues to a year of clinical experience using dual-sex (trainee-supervisor) therapy teams; trainess treat an average of four dysfunctional couples. The authors suggest that the program can serve as a possible model for other centers.


The differential effects of chlordiazepoxide and oxazepam on hostility in a small group setting. The authors compared the effects of chlordiazepoxide, oxazepam, and placebo on hostility, as an inner motivational or arousal state, in moderately and highly anxious male research volunteers. The data again supported the hypothesis that clordiazepoxide-induced increases in motivational hostility are more frequent and intense than those associated with placebo and oxazepum. The data also suggest that oxazepam may be a more specific "hostility tranquilizer" than other benzodiazepines.


Deanol in the treatment of tardive dyskinesia. A patient who developed severe tardive dyskinesia after the termination of long-term phenothiazine therapy was successfully treated with deanol, a possible precursor of acetylcholine. Physiological measurements were obtained to quantify the clinical course. The authors discuss the practical and heuristic implications of these observations and suggest further consideration of therapy directed toward enhancement of cholinergic activity in the central nervous system.


Amitriptyline-perphenazine overdose producing delayed hypomania in manic-depressive illness. The authors describe a 26-year-old woman who became hypomanic after awakening from a semicomatose state induced by an overdose of amitriptyline-perphenazine (Triavil). She had been depressed and had a strong family history of manic-depressive illness. The case is reported to support previous evidence that dopamine is a mediator for mania.


Treatment of somnambulism in military trainees. Of 12 otherwise health individuals facing honorable discharge from the military because of intractable sleepwalking, six chose to participate in a short-term treatment program involving hypnosis. Four of these reported total alleviation of symptoms. Therapeutic design and treatment implications are discussed and a brief review of the literature is presented.


Art and drama: partners in therapy.

Art and drama: partners in therapy. An art-drama therapy group for latency-age boys made possible the exploration of personal symbols and intense fantasies which resulted in a therapeutically powerful and productive experience. This paper describes the background, rationale, and dynamic process of this group. Multimodal expressive arts therapy is supported.


Development and treatment of pseudo-mental illness. This article describes common life-history themes and intervention strategies with 25 patients who seemed overeager to regard themselves as mentally ill and had aggressively sought treatment for more than two years with little improvement. What they seemed to require was an approach that challenged this self-image, and helped them to organize their past experiences around a more constructive and satisfying identity.


Dependence and psychotherapy--developmental considerations. This article illustrates how the assessment of the level and degree of dependency in psychotherapy can be used as a diagnostic and therapeutic tool. Dependency varies with the stage of psychosexual development, with the degree and state of illness, and with the stage of treatment. Appropriate monitoring of this factor promotes optimal growth potential in the patient.


The devil-priest syndrome.

The devil-priest syndrome. Men frequently relate to women as either "sanctified" and hence, asexual, or as sexual, and therefore "degraded." A case is presented demonstrating a similar finding in a woman. The uncovering of the "Devil-Priest Syndrome" during psychotherapy is described. Some speculations as to the significance of this finding in the understanding of the psychodynamics of sexuality are included.


The victimizer: recognition and character. A particular personality type, the victimizer, is an important component of destructive conflict. A victimizer syndrome includes a deep sense of deprivation and loss with a need for restitution, and a perception of the self as ineffectual in producing changes in his own life. The possible origin of the syndrome and societal effects on it are also discussed.


Physiologic correlates of affect during psychotherapy. Eight physiologic parameters were correlated with global ratings of affect intensity in four psychotherapeutic interviews with one patient. Highly significant covariation of affect with five of the eight physiologic parameters was obtained. It was concluded that affect intensity may be a useful psychologic parameter in studying psychophysiologic relationships in psychotherapy.


The lure of magic thinking.

The lure of magic thinking. The development of the thinking processes from childhood to maturity is analyzed and three stages are distinguished: the magic omnipotent stage of the preschool child, the development of the realistic ego, and the future-directed value-building superego. The role of the lure to return to the magic thinking in our culture is described.


Psychotherapy of moral masochism.

Psychotherapy of moral masochism. The psychotherapeutic approach to sadomasochism is discussed with clinical examples. The necessary attributes of the therapist and specific therapeutic techniques are emphasized so as to avoid the destructive, uncontrollable negative therapeutic reactions. A better modulated transference can be interpreted with beneficial results.


Four therapeutic approaches to the same patient. A study of the Truax variables. Interviewing behavior of psychiatrists representing the Gestalt, Psychoanalytic, Kleinian and Jungian schools of psychotherapy are rated using the Truax-Carkhuff measures of accurate empathy, nonpossessive warmth and genuineness. Although similarities of behavior were found, there were significant behavioral differences that coincide with the theoretical models.


Operant conditioning and psychoanalysis: contrasts, similarities, and some thoughts about integration. An operant conditioning orientation and a psychoanalytic one are compared, in terms of differences and likenesses, on a number of dimensions. A few ideas are offered as to why advocates of each approach have generated more heat than light in their discussions with one another; and thereby worked against mutual enrichment and integration of the two viewpoints.


Some behavioral techniques in community psychiatry. Behaviorist principles operate observably in all aspects of animal life, hence in all therapies and in the community at large. Application of these principles strengthens treatment, notably with unsophisticated clients and sociopaths commonly encountered at Community Clinics. It also makes the program more sellable to taxpayers. Various techniques are described.


Social mobility and psychiatric disorder: a re-evaluation and interpretation. There has been growing interest in social mobility (that is, an individual's movement within a social system) and the problems associated with it. This paper shows that the rates of psychiatric disorder are a function of (a) social mobility, (b) direction of mobility, (c) distance moved, (d) the locus of mobility in the status hierarchy. A central concept in this discussion is the concept of "anomie."


Behavior cytogenetics and Turner's syndrome: a new principle in counseling and psychotherapy. In the orthodox theory and practice of psychotherapy and counseling, each case is considered to be unique or idiodynamic in terms of psychodynamic history. According to a new and still unorthodox principle, a syndrome may have a common psychodynamic denominator, shared by all or most carriers of the syndrome. As illustrated with reference to Turner's (45,X) syndrome, application of this new principle expedites the psychodiagnostic and psychotherapeutic procedures.


Psychotherapy and race: interracial therapy under apartheid. In this paper the authors cite examples of problems experienced in conducting psychotherapy in a highly prejudiced societal context-South Africa. The conclusion is drawn that not enough attention is paid to sociopolitical exigencies in the formulation of the goals of therapy and the role of the psychotherapist.


Dream analysis in brief psychotherapy.

Dream analysis in brief psychotherapy. Dream analysis increases participation in brief analytic psychotherapy through interpretation of currently meaningful content. This transition and the sharing of the dream with the therapist helps develop increased self-awareness and recognition of the patient's ability to make self-initiated decisions rather than remain helpless in the face of current conflict.


Interrelationships among patients, medical students and resident psychiatrists. The authors have investigated the interrelationships among psychiatric resident physicians, medical student clerks, and patients on the inpatient psychiatric wards in two teaching hospitals. Medical students tended to focus on establishing rapport with patients whereas psychiatric residents tended to focus on psychopathology and management.


The mental content of puerperal psychoses. The mental concept of puerperal psychoses is considered as having important determinants in body image disturbances. A case is presented of a woman who had had postpartum psychiatric disorders after the birth of each of her two daughters, and who suffered a relapse in identification with her parturient younger daughter.


Behavior modification in the home with students as co-therapists. This case report illustrates the application of behavior modification techniques for managing children's misbehavior. The important elements of this report are the use of graduate students as co-therapists, the implementation of the program directly in the family's home, and the focus on shaping the mother's disciplinary behavior.


Superego factors in alcoholics.

Superego factors in alcoholics. This paper discusses superego fixations and regressions that predispose to and are caused by alcoholism. Two continua of superego functioning are explored, (1) the extent of internalization vs. externalization and (2) regulation of behavior vs. self-castigation. The superego constellations in guilty, binge, sociopathic, and deteriorated alcoholics are delineated to explain the interaction of a treatment program with these patients.


Tandem psychotherapy: a model for rotating student therapists. Student psychotherapists often spend relatively brief periods in clinical placements or rotations. In this article, Lewis R. Wolberg's model for short-term therapy is extended and adapted for use in long-term treatment by multiple student therapists treating patients in tandem. Techniques are proposed to enhance continuity of therapy and smooth changing of therapists.


Homosexuality: some diagnostic perspectives and dynamic considerations. Homosexuality as a diagnostic category has been of limited value since the sexual functioning, ego development, and object relations of patients are not always correlated. Considering homosexuality as a complex configuration resulting from the interplay of unconscious drives with defensive processes and adaptive implications offers a comprehensive dynamic approach. Illustrative case material is presented.


The use of wit and the comic by a borderline psychotic child in psychotherapy. The ego strengthening use of wit and the comic by a borderline psychotic child is discussed. Serving a valuable defensive function, this patient's use of wit allowed him to eventually confront the despair beneath the comedy. Specific techniques for therapeutic reinforcement of wit are suggested.


A comparison of program and contraceptive use continuation rates in a family planning clinic. Programs and contraceptive use continuation rates were obtained for a rural Georgia family planning clinic. Program continuation is a measurement of maintenance of clinic attendance, while use continuation is related to actual use of effective contraceptives regardless of clinic activity status. Program continuation rates ranged from 0.77 at 12 months to 0.48 at 36 months. Contraceptive use continuation rates were 0.78 at 12 months and 0.58 at 36 months. Women who moved or were otherwise lost to follow-up formed the largest category of discontinuation. The highest rate of discontinuation from clinic attendance occurred after the first visit with secondary peaks around the time of scheduled annual checkups. Women who were younger and had fewer living children had a greater likelihood of discontinuing clinic attendance and contraceptive use. The reasons for and timing of discontinuation from clinic attendance suggest that clinic personnel should place special emphasis on the first visits, arrange referral for women who might have plans to leave the service area before the scheduled return visit, send reminders before first revisits, and follow up patients soon after missed visits. Priority might be assigned to the younger women of low parity who have been shown to be at higher risk of discontinuation. Other factors which might influence continuation include method of contraception, marital status, and race. Program continuation can be determined by analysis of clinic records alone while contraceptive use continuation often requires follow-up of patients. Although the two continuation rates were not equivalent, program and use continuation were roughly parallel through much of the study period. This suggests that a simple review of records in the clinic or on computer tape, when available, to determine program continuation may give an estimate of actual contraceptive use in the population.


Intrauterine device retention: a study of selected social-psychological aspects. A retrospective study of the association between selected sociopsychological variables and the early discontinuation of intrauterine device use was carried out among patients of the Central Clinic of Family Health, Inc., New Orleans, Louisiana. In toto, 270 women cooperated in a standardized interview which was administered by trained auxiliaries of the clinic's staff; Investigation of sociodemographic characteristics shows a greater proportion of the terminators to be younger, more mobile, and to have experienced more changes in marital partners. Continuers are at greater health risk in pregnancy as rated by the clinic at time of admission, but do not verbalize this as a concern. Responses relating to sexuality image and contraceptive attitudes indicate that a greater proportion of the terminators dislike an internal IUD self string check, hold a more pro-pregnancy attitude, do not feel dependent on the availability of contraceptives, and currently utilize the less effective contraceptive methods. Few significant differences are reported in the side effects experienced after IUD insertion by the terminators or continuers. However, the groups hold decidely different perceptions of the meaning of such complaints. A greater proportion of the terminators perceive themselves as being sick, take to bed during the menses, find that complaints disrupt their normal household activities, and are fearful of the meaning to their health of the difficulties experienced. The majority of both groups are functioning in a segregated marital role pattern. Terminators portray a tendency to be interacting with more "traditional" husbands who visualize the proper role for their wives as mothers whose duty it is to stay home. Continuers, to a greater degree, are more dominant individuals, make more decisions in the running of the home, and feel that contraception is their responsibility alone. Program implications take direction from the findings that the terminator is a more "costly" patient in terms of physician time and is at a decidely greater risk of final closure to all clinic contacts.


Menstrual regulation in family planning  services. Menstrual regulation is a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiration for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postcontraceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.


Bone changes in congenital biliary atresia. Radiologic observation of 8 cases. In reviewing 38 cases of biliary atresia, 8 cases were detected to have osseous abnormalities. We found definite generalized demineralization of bones in 3 cases, metaphyseal abnormalities in 5 cases, and fractures in 4 cases. Marked demineralization of bones was seen in cases in which the clinical course was more than 1 year. No good correlation was observed between osseous changes and severity of liver dysfunction.


Joint changes in idiopathic hemochromatosis. Two patients with idiopathic hemochromatosis and a distinctive arthropathy are presented. The joint findings are characterized by joint narrowing, prominent osteophytes, subcondral sclerosis and multiple lucent subchondral cysts, and chondrocalcinosis. The etiology of this arthropathy and its relationship to chondrocalcinosis are discussed. Occasionally, patients may present with this arthropathy before the onset of the classical signs of idiopathic hemochromatosis.


Neurogenic disorders of the foot in diabetes mellitus. Neurogenic disorders of the foot in diabetics have been found with increasing frequency in recent years, Therefore, familiarity with the spectrum of roentgen findings appears essential. Significant changes include Charcot joints of the tarsus (destructive type), and bone absorption of the forefoot (multilating type). Charcot joints have been observed in 11 patients, bone absorption in 12, and a combination of both types in 3. This combination strongly suggests a diabetic neuropathy. Pathogenesis and differential diagnosis are briefly discussed.


The navicular fat stripe: a useful roentgen feature for evaluating wrist trauma. The navicular fat stripe (NFS) is a useful roentgenographic feature for evaluating traumatic wrist injury. A radiolucent stripe, cast by a thin collection of fat paralleling the lateral surface of the navicular bone, was seen in 96 percent of 400 normal wrists examined because of trauma. Obliteration or displacement of this line (positive NFS sign) is commonly present in acute fractures of the naviculum, radial styloid process, and proximal first metacarpus. A ositive NFS sign serves to alert the radiologist that an underlying fracture is likely. In particular, the NFS sign generally accompanies a navicular fracture.


Roentgenographic anatomy of the tendon sheaths of the hand and wrist: tenography. The radiographic anatomy of the tendon sheaths of the hand and wrist is described. Contrast evaluation, tenography, of these synovial-lined channels utilizing 10 cadaver limbs was accomplished outlining their relationship to adjacent osseous and articular structures. The technique is simple and provides the radiologist with further understanding of the pattern and distribution of roentgenologic alterations accompanying septic and granulomatous processes of the hand and wrist including "horeshoe abscesses" of the palm, osteomyelitis, pyarthrosis, and rheumatoid tenosynovitis. Tenography should be added to the radiologist's ever-increasing armamentarium.


Patterns of migration of the femoral head in osteoarthritis of the hip. Roentgenographic-pathologic correlation and comparison with rheumatoid arthritis. Characteristic roentgenographic patterns of femoral head migration occur in osteoarthritis of the hip. In a study of 100 patients superolateral migration was noted in 15, superomedial in 48, superior migration of intermediate type in 15, and medial displacement of the femoral head in 22. Correlation with pathologic specimens obtained following total hip replacements and comparison with patterns of femoral head migration in rheumatoid arthritis were accomplished. It would appear that anatomic features of the acetabulum are of prime importance in the determination of the type of femoral head displacement complicating osteoarthritis.


Bone and soft tissue abnormalities of the upper extremity in diabetes mellitus. Roentgenographic evidence of bone and soft tissue abnormalities may be noted in the upper extremities of diabetics. Major shoulder changes, typically associated with peripheral neuropathy, include humeral head deformity due to bone resorption, joint space narrowing, subchondral cysts and sclerosis, subluxation, and juxtra-articular soft tissue bone fragments. Charcot-type joints, characterized by severe joint destruction, sclerosis, multiple bone fragments, and soft tissue swelling may occur. Diabetic neuropathy can produce flexion contractures of the hand. Abnormalities not necessarily associated with clinical neuropathy include cystic bone changes, cortical bone erosions, soft tissue calcification (calcific tendinitis), and vascular calcification.


Occult central fractures of the acetabulum. Four cases of occult central acetabular fractures are presented. The oblique plane of the fracture line and the lack of displacement of the fracture fragments made the fractures difficult of impossible to visualize in the anteroposterior projection. The posterior oblique projection placed the fracture line perpendicular to the x-ray beam and, therefore, evident on the resultant roentgenogram. In the 3 cases in which this view was obtained, the fracture was disclosed. In the fourth case the fracture was demonstrated by tomography. In order to improve the roentgenographic assessment of pelvic trauma, consideration should be given to obtaining posterior oblique views of the pelvis as a matter of routine.


The cardiovascular effects of dantrolene sodium in dogs. The effects of the intravenous infusion of dantrolene sodium and of equal volumes of normal saline on arterial pressure, central venous pressure, heart rate and cardiac output have been investigated in healthy, anaesthetised dogs. The infusion of dantrolene in the manner and dose found to be effective by other workers in pigs-8 for the treatment of anaesthetic induced malignant hyperpyrexia, produced changes which differ little from those observed after the infusion of a similar quantity of saline. These results are discussed.


An unusual case of malignant hyperpyrexia. First reported case in a South African negro. A case of malignant hyperpyrexia with unusual features in a South African negro child is described. The diagnosis was confirmed by the clinical presentation and laboratory investigations. Aspects of treatment and subsequent successful anaesthetic management are discussed.


A variable orifice spigot. A modified dennison "valve". An inexpensive "home-made" version of the Dennison-1 "valve" is described which appears to be more satisfactory than those which are currently available.


The premedication of cardiac surgical patients. A clinical comparison of four regimes. One of four groups of patients was not premedicated; the others received diazepam 10 mg by mouth, diazepam 20 mg by mouth or a combination of pentobarbitone orally and morphine and hyoscine intramuscularly. The cardiovascular and respiratory parameters were studied before and after the premedication and any changes in sedation, apprehension and reaction to pain were noted. The ease of induction of anaesthesia in the four groups was compared. Most of the patients who received the pentobarbitone, morphine and hyoscine combination came to theatre calm, sedated and often asleep. They showed no significant cardiovascular or respiratory depression and the induction of anaesthesia was more satisfactory than in the other groups. Two of the patients who were not premedicated became very agitated in the ward and the remainder of the patients in this group were apprehensive in the anaesthetic room and during induction. The effects of diazepam in the two doses studied were intermediate between those who received the pentobarbitone, morphine and hyoscine and those who were not premedicated.


Sedation for local analgesia. Distraction and diazepam. An approach to the patient is described that is of value when operations are performed under local analgesia during intravenous sedation with diazepam. The technique involves maintained distraction of the patient with some phantasy of his own choice. All mention of the different stages of the procedure is deliberately avoided.


The aims and aspirations of senior registrars. A study was made of the intentions and interests of anaesthetic Senior Registrars in the United Kingdom between March and May 1974. It is hoped that examination of the findings will show some of the features which make a consultant post attractive. A great deal of goodwill for the United Kingdom was demonstrated but it should be pointed out again that this was before the upheaval within, and about, the National Health Service which erupted at the end of 1974 and the beginning of 1975. It would seem vital that the necessary steps are taken to keep the goodwill of this substantial number of potential consultant anaesthetists so that the many lightly veiled threats of emigration are not taken to their logical conclusion.


Accidental intravenous injection of cetrimide. A case report. An unusual case of cetrimide toxicity, probably the first of its kind to be recorded, is reported. It occurred after accidental intravenous injection in an infant and the management is discussed. Cardiac arrest, muscle paralysis, haemolysis and other complications were successfully treated.


Evaluation of the IMI portable oxygen analyser. An evaluation of the IMI oxygen analyser is described. The accuracy was found to be adequate for clinical purposes though it was considered that this could be improved if the meter was read with greater discrimination than the existing calibrations and if the zero could be adjusted.


An equipment logging system.

An equipment logging system. The application of Strafoplan logging to equipment used in the Intensive Care Unit is described and discussed.


Pseudocholinesterase activity of human whole blood, bank blood, and blood protein solutions. Pseudocholinesterase (E.C. 3.1.1.8) activity was measured in plasma of whole blood, bank blood, and several commercially available blood protein solutions by means of a colorimetric assay technique at 25 degrees C, pH 7.7, and with butyrylthiocholine as substrate (Merckotest-R No. 3337). Activity of whole blood was 5.79 plus or minus 0.20 U x ml-1, of bank blood 4.53 plus or minus 0.27 U x ml-1, and of two human serum solutions (Biseko-R, Seretin-R) 3.05 plus or minus 0.13 and 3.04 plus or minus 0.22 U x ml-1, respectively (mean plus or minus S.E.M.). The other blood protein solutions contained no clinically significant esterase activity. Since transfusion of blood plasma has been suggested for treatment of cholinesterase deficiency and postoperative suxamethonium-induced muscle paralysis, an in-vitro attempt was carried out to correlate the amount of plasma necessary and the rise of pseudocholinesterase activity in the recipient's blood: A large amount of blood has to be transfused to yield a comparatively small increase in esterase activity. Thus, considering the potential hazards of blood transfusion, this treatment does not seem to be advisable.


[Experimental studies in animals on the question of liver damage following halothane anaesthesia and hypoxia (author's transl)]. The influence of single or multiple halothane anaesthetics on the liver enzyme pattern was investigated utilizing 270 female rats. The additional stress of hypoxia (12 percent inspired oxygen) did not result in quantitative or qualitative differences as compared to the normoxic groupmmultiple halothane anaesthetics caused reversible enzyme changes in the serum as well as in the liver homogenate.


[Swelling and loss of potassium in perfused livers following the influence of the vapours of carbon tetrachloride, chloroform and halothane on the perfusion medium (author's transl)]. Erythrocyte free perfused rat livers were treated with vaporous carbon tetrachloride, chloroform and halothane by equilibration in the oxygenator system. The potassium loss, the amount of swelling and the alteration of the perfusion rates were measured during the experiments as criteria of acute toxicity. In contrast to the well known behaviour of perfused livers during the intoxication with phalloidin the amount of liver swelling did not marekdly depend on the perfusion rates in acute CCl(4) poisoning. The mechanism of swelling must be different in both intoxications. Exposure of perfused livers to high concentrations of CCl(4) for several minutes only produced a marked K-+-loss within a short time. This injury could not be fully compensated after finishing the exposure. Dose response diagrams are presented for carbon tetrachloride, chloroform and halothane by use of the following criteria: potassium loss, swelling (increase of wet weight) and perfusion rates (ml.min-1.g-1). As total doses the amounts of solutes vaporized during the exposition were listed. In these diagrams chloroform appears to be more toxic than halothane. CCl4 occupies a middle position between chloroform and halothane. The course of dose response diagrams of halothane is different from those of CCl(4) and CHCl(3). The halothane diagrams increase critically at high doses, whereas the courves for CCl(4) and CHCl(3) rise continuously. With respect to effects on the hepatic microcirculation halothane seems to be less toxic than CCl(4). The results are discussed on the basis of the periods of exposition and the maximal concentrations of the solutes in the perfusion medium. With respect to these data CCl(4) is much more toxic than CHCl(3) and halothane. On the other hand there is no marked difference in acute hepatotoxicity between CHCl(3) and halothane.


[The influence of ethrane on the electro- and pentylenetetrazol-convulsions in mice (author's transl)]. The influence of Ethrane upon electro shock and pentylenetetrazol-induced convulsions was studied in mice. Similar to other inhalation anaesthetics and to barbiturates Ethrane exerts a powerful anticonvulsive activity. There is a dose response relationship between the rate of electro shock (20 mA/0.2 sec) induced convulsions and inspiratory Ethrane concentration, convulsions being completely prevented by 1.5 vol.-percent of Ethrane. The LD(50) of pentylentetrazol increases five fold under a 2 vol.-percent Ethrane anaesthesia.


[Experimental studies in animals on the bladder function following sacral blockade with alkohol (author's transl)]. Caudal anesthesia was achieved with Xylocain-R in 13 dogs and with ethanol (99,2 percent) in 8 dogs. Urinary bladder function was studied before and after block. The results obtained are in agreement with the functional changes after rhizotomy of S1--S3: bladder capacity increases after cuadal block and pressures measured at equal volumes decrease. Urinary overflow was observed; 80 percent of the filling volume, however, remains within the bladder. An autonomous bladder contraction induced by smypathetic nerve activity could not be proven within our observation period of 7 days.


Acute transient swelling of the salivary glands during and following endotracheal anaesthesia. A report is presented of five cases of transient swelling of salivary glands during and following endotracheal anaesthesia. No definite relation between the glandular swellings, sex, premedication, anaesthesics and type of surgery was found. The cause of the salivary gland swelling is, at present, unknown. However, "bucking", straining and/or the procedure of endotracheal intubation may be the most likely contributing factors. Although the swelling was of short duration and was benign, we should be familiar with the possible causes, the signs and the lack of clinical significance, in order to avoid unexpected anxiety to the patient.


[Report on a partial necrosis of the tongue caused by an endotracheal tube (author's transl)]. The case is presented of a patient in whom, because of a bleeding submental arterio-venous haemangioma both external carotid arteries were ligated. IPPR via an endotracheal tube was required for 18 hours after operation. Local necrosis of the tongue developed as a result of pressure from the endotracheal tube. The patient became symptomfree after necretomy of the tongue.


Studies on the liver of Xenopus laevis. II. The ultrastructure of the peritoneal cover and the perihepatic layer. The peritoneal cover and the subcapsular region of the liver of Xenopus laevis were examined with electron microscopy. In the subcapsular region a prominent perihepatic layer two to ten cells wide was found. This perihepatic layer is mainly composed of granulocytopoietic tissue. Other cell types found in the perihepatic layer were lymphocytes, pigment cells and fat storing cells. The presence of a perihepatic granulocytopoietic layer in the liver of Xenopus laevis is in contrast to current opinion that such a layer is a characteristic typical of urodeles. The phylogenetic significance of such a layer in anurans and the developmental processes of the individual cell types of the perihepatic layer are discussed. Furthermore the possible participation of the perihepatic layer in the immune response is considered.


Quantitative investigations of visual brain structures in wild and domestic sheep. A cytoarchitectonic subdivision into visual structures and neocortical grey and white matter has been made from frontal serial sections of brains of mouflons (Ovis ammon musimon) and domestic sheep (Ovis ammon f. aries). The reduction rates determined for the volumes of the brain areas are calculated by means of intraspecific allometric methods. The overall decrease of visual brain structures in domestic sheep compared with wild sheep amounts to 25.9%, The greatest reduction is found in the striate area (30.2%), followed by the lateral geniculate body (25.4%), the optic tract (20.6%) and finally the superior colliculus (12.1%). The neocortex as a whole decreases in sheep under domestication by 26.4% in volume. The reduction rate of neocortical grey matter amounts to 24.9%, that of the white matter to 28.9%. The changes of brain size in domestic sheep may be functionally correlated to changes of the environmental conditions which are due to domestication.


In utero development and maturation of the retina of a non-primate mammal: a light and electron microscopic study of the guinea pig. A light and electron microscopic examination of retinogenesis in the fetal guinea pig has revealed an early development of synapses and photoreceptor cells. Differentiation of the neural retina begins around day 23 of gestation. By 34 days the retina reaches its maximum thickness. It differentiates an inner plexiform layer in which vesicle-containing processes and primitive synapses are evident. Synaptic ribbons are found in processes of this layer by 43-45 days of gestation. An outer plexiform layer develops within the neuroblast layer at 40 days of gestation; from its first appearance the outer plexiform layer contains synapses complete with synaptic ribbons. Receptor terminals of the alpha, paranuclear and beta type are present well before birth. Photoreceptor cells form inner segments by 40 days; the formation of outer segments is indicated by 45 days but not widespread until 49 days. The retina appears mature by day 51-57. It is clear that the primate is not unique in the early differentiation of its retinal synapses relative to the time of maturation of its photoreceptor cells. The potential functional capacities of precocious retinae, and the mechanisms of synapse development are discussed.


Direct and mediated effects of testosterone: the development of intersexes in sex reversed mosaic mice, heterozygous for testicular feminization. The X-linked Tfm mutation causes androgen insensitivity in the target cells of testerone. Due to random X-inactivation, XX-mice heterozygous for Tfm are mosaics in respect to androgen sensitivity. By the autosomal "sex reversal" mutation, Tfm-heterozygotes were converted to males during embryonic life so that male sex organs developed in which the mosaic was expressed. The mutual influence of both components of the mosaic is analysed. It is shown that cellular differentiation is directly induced by testosterone, while the formation of organ anlagen and proliferation are locally mediated effects.


Hyperglycemia in the NZB/NZW F1 hybrid mouse. Both the NZW and NZB mice exhibit an elevated fasting blood sugar level when compared to Swiss white mice. The NZB/NZW F1 hybrid mouse shows still a higher fasting serum glucose level than either of its parental strains. The elevated glucose level is noted very early in the animals' life, long before definitive signs or symptoms of pathology are evident, and remains elevated at least until the fortieth week of life, the last testing period in our series before sacrificing the aminals. There are two major peaking periods for the glucose levels, namely at 4-10 weeks of age and then again at 31-40 weeks of age. These age periods correspond to the very young animal and to the animal that is beyond its prime and most likely sick and near the end of its lifespan due to the animals' inherent disease processes. The NZB and NZB/NZW F1 hybrid succumb to their disease processes at approximately 8-10 months of age. The NZW usually lives until 18 months. The questions are raised: does the altered immunologic state in the NZB and/or the NZB/NZW F1 hybrid produce the elevated blood sugar levels and the pancreatic histopathology or is it the early hyperglycemic condition coupled with pancreatic pathology which are in some measure instrumental in producing the lesions discussed and observed, in the beginning of the three to four month period of age, in the various organs? Is there a relationship between the hyperglycemic condition and the immune state or are these independent phenomena in a genetically "mixed up" mouse?


Structure of rat bile canaliculi as revealed by scanning electron microscopy. Bile canaliculi in the rat liver have been studied by scanning electron microscopy. They appear as half tubules carved out of the hepatocytes' surface. In several cases the bile channel bifurcates to form two or three long branches running on the same face of the cell. Therefore, by SEM it seems obvious that the same side of an hepatocyte may be used for bounding two or more bile canaliculi. Some bile canaliculi display a flexuous course and show lateral sacculations. Some of them are large and apparently similar to the short lateral branches of the bile canaliculus; others are smaller and arise obliquely from the subjacent cortical areas of the hepatocyte cytoplasm. These latter structures are best observed in stereo-views in which they appear as narrow intracellular projections bordered with a few microvilli, actually opening into the lumen of the bile canaliculus. The SEM results suggest that these sacculations probably correspond to short intracellular branches of the bile canaliculi. Zones of minimal distance (0.1 mu) between the space of Disse and the bile channel have been frequently observed. They are actually the zones where the intercellular clefts arising from the subendothelial space of Disse come into closet contact with the bile canaliculus and might serve as sites of simple diffusion of substances.


Depolarization block and phase II block at the neuromuscular junction. The effects of repeated doses of decamethonium or succinylcholine in muscles of the cat, dog, and rabbit have been examined.  In particular, the relation of degree of neuromuscular block to intensity of the electrical change at the end-plate region has been found to be more consistent when the peak spatial gradient of depolarization is used as a measure of electrical effect  than when the peak depolarization is used; the reason for this difference is discussed.  A plot of twitch height against electrical change provides a convenient frame of reference for following the development of phase II block quantiatively.  Examples presented show that the extent and kinetics of phase II block can vary considerably among species or among muscles in a given species.


Mitosis in mammalian cells during exposure to anesthetics. The effects of methoxflurane, trichloroethylene, chloroform, halothane and diethyl ether on the division of Chinese hamster fibroblasts in spinner culture have been studied. All agents caused dose-dependent inhibition of cell multiplication. Halothane increased the cell cycle time roughly in accordance with its effect on multiplication rate. There was no evidence that mitosis was greatly prolonged, and only small numbers of "c-metaphases" were seen. However, exposure to halothane resulted in a marked and rapid reduction in the prophase count, suggesting prolongation of G2 (the post-synthetic phase). Cine-photo-micrography showed frequent delay in division of cytoplasm at mitosis, and many binucleate cells were seen.


Diphenylhydantoin and lidocaine modification of A-V conduction in halothane-anesthetized dogs. The effect of halothane on A-V conduction was evaluated in gods during atrial pacing using the  technique of His-bundle electrocardiography. In addition, the effects of lidocaine and diphenylkydantoin (DPH) on A-V conuction were examined during halothane anesthesia. Effects of these drugs  on three subintervals of A-V conduction were compared. These included the -H (stimulus atifact of His-bundle deflection-atrioventricular conduction), H-Q (His-budnle deflection onset of QRS complex-His-Purkinje conduction), and H-S intervals(His-bundle delfection to end of QRS COmplex-total intraventricular  conduction). Linear regression best described the relationship between duration of interval (P-H, H-V,and H-S) and heart rate during incremental increases in the atrial paced rate. Data from these experiments were fitted to a multiple lenear regression model that predicted the effect of increasing concentrations of halothan, lidocaine, and DPH  on slope and intercept coefficients. In creasing concentrations of halothan ( 30 and 45 mg/100 ml arterial). Both lidocaine and DPH further depressed conduction at all levels of halothan anesthesia. The P-H interval was particularly sensitive todrug effefts. This may represent potentiation of the normal slowing of conduction through the AVnode in response to incremental increases in heart rate (fatigue response.) We conclude thatboth lidocaine and DPH fail to reverse the depressant effect of halothane on A-V conduction. This may explain their ineffectiveness in treating certain types of arrhythmias during halothane anesthesia.


Left ventricular performance and pulmonary circulation following addition of nitrous oxide to morphine during coronary-artery surgery. The effects of nitrous oxide on ventricular performance and pulmonary circulation were studied in 12 patients with angiographically demonstrated coronary-artery disease and normal ventricular contractility who had received 2 mg/kg morphine intravenously. Seventeen studies were performed intraoperatively, five before and 12 after cardiopulmonary bypass and myocardial revascularization. Recordings were obtained during oxygen breathing and during nitrous oxide administration. Fifty per cent nitrous oxide significantly decreased mean arterial pressure (P less than 0.05), cardiac index (P less than 0.01), stroke index (P less than 0.01), left ventricular stroke work index (P less than 0.01), peak left ventricular dP/dt (P less than 0.05) and dP/dt/P (P less than 0.01), and heart rate-systolic arterial pressure product (P less than 0.01). Mean pulmonary arterial pressure (P less than 0.05), pulmonary artery occluded pressure (P less than 0.01), left ventricular end-diastolic pressure (P less than 0.01) and pulmonary vascular resistance (P less than 0.05) increased. Heart rate, right atrial pressure and systemic vascular resistance remained unchanged. When nitrous oxide was discontinued, all variables returned to control except mean pulmonary arterial pressure and pulmonary vascular resistance. Responses were similar before and after cardiopulmonary bypass and myocardial revascularization. These findings suggest that nitrous oxide depresses left ventricular performance when administered intraoperatively to patients who have received large doses of morphine for coronary-artery surgery. Nitrous oxide also increases pulmonary vascular resistance, possibly via alpha-adrenergic stimulation.


[Renal effects and metabolism of sevoflurane in Fisher 3444 rats: an in-vivo and in-vitro comparison with methoxyflurane]. Sevoflurane, 1.4 per cent (MAC), was administered to groups of Fischer 344 rats for 10 hours, 4 hours, or 1 hour; additional rats received 0.5 per cent methoxyflurane for 3 hours or 1 hour. Urinary inorganic fluoride excretion of sevoflurane in vivo was a third to a fourth that of methoxyflurane. However, using hepatic microsomes, sevoflurane and methoxyflurane were defluorinated in vitro at essentially the same rate. The discrepancy between defluorination of sevoflurane and methoxyflurane in vivo and in vitro was probably due to differences in tissue solubility between the drugs. There were no renal functional or morphologic defects following sevoflurane administration. An unexplained adverse effect was significant weight loss, which occurred following all exposures to sevoflurane.


Pathophysiology of hyperkalemia induced by succinylcholine. SCh is unequivocally contraindicated in the management of patients who have sustainded thermal trauma or direct muscle trauma and those who have neurologic disorders involving motor deficits, including tetanus.  The mechanism is clear in some, but not all, of these conditions, and is related to increased chemosensitivity of the muscle membrane due to the development of receptor sites in extrajunctional areas.  Though SCh induces a small release of K+ in normal muscle, it produces a potentially lethal efflux in the presence of increased sensitivity.  This K+-releasing action of SCh begins about 5 to 15 days after injury and persists for 2 to 3 months in patients who have sustained burns or trauma, and perhaps 3 to 6 months in patients with upper motor neuron lesions.


Allergy epidemiology in the St. Louis, Missouri, area. III. Trees. A population skin-tested with pollen from twelve wind pollinated tree species showed a variable level of allergenicity, particularly among adults. Pollen extracts of Box Elder, Willow and Hickory elicited the highest allergic reactions, Oak, Birch, Sycamore, Black Walnut and Poplar more moderate reactions, while allergens from Cottonwood, Maple, Elm and White Ash were less reactive. Since Box Elder is ubiquitous and produces a strongly positive reaction among adults, it should be included among skin tests of those patients known to be allergic to early spring pollen.


Ultrastructure of canine articular cartilage: comparison of normal and degenerative (osteoarthritic) hip joints. Normal canine hip cartilage was compared with cartilage from the degenerative lesions found in young dogs with canine hip dysplasia. The upper 0.5 mm of normal cartilage was characterized. Four distinct layers or zones were found: a layer of fine fibrous material covering the surface, a layer (surface layer) of small (32 nm diameter or less) collagen fibrils tightly packed in bundles and oriented parallel to the surface, a layer (upper layer) or less tightly packed collagen fibrils oriented mostly parallel to the surface with about 33% of the fibrils 64 nm or more, and a layer (intermediate layer) of randomly oriented fibrils with more than 50% of the fibrils 64 nm or larger. Fibril density was high in the surface layer and decreased with depth into the cartilage. In a moderately advanced lesion of degenerative cartilage, there was a layer of amorphous material over the surface. The tightly packed surface layer of small fibrils was absent. The surface itself was uneven and fissued. At depths from the surface comparable to the upper and the intermediate layers in normal cartilage, the proportion of large fibrils was less than in normal cartilage. The overall density of fibrils in degenerative cartilage increased with depth into the tissue. Cells flattened parallel to the surface, with relatively large nuclei, were found in the upper layer of normal cartilage. Cells in the intermediate layers were larger and round. The oblong cells of the upper layer of normal cartilage were not found in any layer of degenerative cartilage. Differences between cells in other layers of normal and degenerative cartilages were minimal. A model for the arrangement of chondrocytes and collagen fibrils for normal and degenerative cartilage was proposed. Ultrastructural changes in degenerative cartilage were prominent in the upper 0.5 mm of cartilage. These changes were changes in the number of collagen fibrils/mum-2 and a change from a characteristic pattern of collagen fibril diameters and orientation found in normal tissue.


Ophthalmic manifestations of induced sickling of erythrocytes in Japanese sika deer (Cervus nippon). Nine female Japanese sika deer (Cervus nippon) were used in a total of 25 experiments in which sickling was chemically induced. During these experiments, color fundic and color fluorescein photographs were taken. Fundic changes included retinal vascular attenuation, blood column pallor, and decreased tapetal reflectivity. These changes were most likely directly associated with a decreased hematocrit and a generalized shocklike condition. Three deer had a congested appearance in retinal blood vessels and tapetum lucidum. Two of the 3 deer developed serous detachment of the retina. These changes seemingly were associated with severe venous statis; all 3 deer died shortly after the experiment was terminated. These experiments yielded data only for the acutely affected deer. None of the ocular changes could be considered the result of chronic sickling because of the reversal of sickling that occurred despite continued intravenous administration of bicarbonate. None of the deer developed ocular changes characteristic of sickle cell retinopathy in human beings. The changes in human beings probably result from continued stress and prolongation of sickling, and especially from a multiplicity of repeated severe episodes of sickling occurring over many years.


Efficacy of two dichlorvos formulations against larval and adult Hyostrongylus rubidus in swine. Coated (V-13) and uncoated (V-22) formulations of dichlorvos were used to treat experimentally established Hyostrongylus rubidus infections of pigs at intervals after exposure to infective larvae. Both dichlorvos formulations were efficacious against the adult stomach worm H rubidus, but showed little or no activity against 5- or 15-day-old worms. Neither formulation was as effective against H rubidus in sows as in barrows and gilts.


Q fever (Coxiella burnetii) investigations in dairy cattle: persistence of antibodies after vaccination. The immune response and persistence of antibodies were investigated in dairy cattle vaccinated with formalin-inactivated phase (ph) I Coxiella burnetii vaccine agglutinating antibody geometric mean titer (GMT) of 193.2 at 1 month after vaccination compared to a GMT of 2.0 for nonvaccinated calves. The agglutinating antibodies gradually decreased in vaccinated cattle, but the GMT remained approximately 4 times higher than that for the nonvaccinated group for at least 20 months. Results of serotests at 2 months after revaccination indicated a rapid increase in the GMT to 177.0 with agglutinating titers between 1:64 and 1:512.


Anthelmintic treatment of subclinical parasitism of feedlot cattle in Georgia. Forty heifer calves, 27 yearling heifers, and 64 yearling steers with naturally occurring infections of nematode parasites were treated with levamisole HCl or morantel tartrate or were not treated. Although heifer calves had much larger worm egg counts before treatment than yearling heifers, necropsies showed a smaller average number of nematodes in the calves. Both anthelmintics significantly reduced the egg counts. At the end of the experiments, 98 to 240 days after treatments, there was no significant difference among groups of cattle in respect to necropsy worm counts. An advantage of 5% in rate of gain in body weight was shown in each experiment or phase of an experiment in favor of the treated groups of cattle. Overall, an advantage of 6% in feed efficiency was calculated for the treated groups of cattle.


Influence of dietary fat upon rats during gestation and lactation. A comparison was made between rats fed purified rations containing different fats during gestation and lactation and rats fed a commercial ration during similar periods. The purified ration containign 20% cocoa butter did not result in appreciable differences in the mothers (body weight, behavior, litter production, and brain chemistry) or in the 1-day-old neonates (brain chemistry). The purified ration containing 20% safflower oil resulted in fewer completed gestation, in poorer maternal behavior during lactation, and in neonates with small brains. A fat-free purified ration resulted in low brain concentrations of RNA and low RNA-DNA ratios in the mothers.


Influence of  maternal dietary fat upon rat pups. Mother rats were fed purified rations containing different fats during gestation and lactation and at 1 day after parturition. Litter sizes were reduced to 2 male and 2 female pups. The behavior and the brain chemical composition of these selected pups were compared with similarly selected pups from dams fed a commercial ration. All offspring were fed a commercial ration after weaning. Pups from dams fed 20% safflower oil were similar to controls. Feeding 20% cocoa butter to dams resulted in pups with reduced exploratory activity and with a rapid learning performance in a T-maze, employing the aversive stimulation of an electrical shock. Feeding dams a fat-free ration produced pups which had reduced rates of growth, small brains at 2 months of age, and low brain concentrations of cholesterol, DNA, and RNA.


Epizootic of fatal amebiasis among exhibited snakes: epidemiologic, pathologic, and chemotherapeutic considerations. An epizootic of reptilian amebiasis seems to have caused the death of 15 to 16 large and valuable captive snakes (boas, pythons, and anacondas) occupying one of 5 large display dioramas in the Steinhart Aquarium of the California Academy of Science, Golden Gate Park, San Francisco. Subsequent review of previous snake deaths in the colony indicated that of 464 snakes that had died since early 1969, 89 snakes had intestinal or hepatic lesions, and 80 of these snakes had pathologic features which involved severe intestinal ulceration, hemorrhage, and massive enteritis, with or without hepatic necrosis and destruction, condition compatible with Entamoeba invadens infection. The present epizootic began in November, 1972, with the death by acute enteritis of a red-tailed boa constrictor (Boa constrictor amarali) and was followed by the loss of 15 other large boids and pythonids. The affected snakes became immobile, refused to feed, and began to die 10 weeks after the death of the red-tailed boa. Seven boa constrictors, 4 pythons, and 4 anacondas from the same diorama died during the ensuing 10 weeks. Entamoeba invadens trophozoites were identified in the stool of the remaining living snake, a 3-m boa constrictor, and in the liver and the intestinal tissue of 1 of the dead boas examined microscopically. The parasite was also found in the stool of a giant Burmese python (Python molurus bivittatus) that died in the adjacent diorama and in the tissues of a blue-tongued skink (Tiliqua scincoides), separately housed, that died of enteritis during this period. Amebic cysts were recovered from turtle and alligator fecal samples taken from a central "swamp," or reservoir, draining the dioramas, water that is returned to the snake display areas after passage through a biological sand-gravel filter and ultraviolet radiation exposure. Cultures from these stools were positive and proved lethal to an experimentally infected boa constrictor. Treatment of the surviving snake in the affected diorama with metronidazole at the dose rate of 275 mg/kg proved rapidly effective; toxicosis was not observed. Other snakes and lizards suspected of having the infection were similarly treated and returned to normal behavior and feeding patterns. Epidemiologic considerations review the probable mode of introduction and spread of this highly lethal snake pathogen and recommendations are made for avoiding infection, prophylactic treatment, and handling of similar epizootics when they do occur among captive reptiles in aquariums, zoos, and research laboratories.


Fetal and maternal lesions in pregnant ewes ingesting locoweed (Astragalus lentiginosus). Locoweed (Astragalus lentiginosus) was fed to ewes from 70 to 100 days of pregnancy. Ewes were killed at 100, 115, 130, and 145 days, and selected tissues were collected from both the dam and the fetus for histologic examination. Neurovisceral cytoplasmic vacuolation and neuroaxonal dystrophy decreased in dam and fetus with time after the feeding of locoweed was discontinued.


Preliminary study of appearance of endotoxin in circulatiory system of sheep and cattle after induced grain engorgement. Edotoxin was detected, using the limulus amebocyte lysate (LAL) test, in the blood of 3 sheep and 1 steer which had been experimentally "overfed" (induced grain engorgement) with a mixture of corn and oats (2:1). The 1st postfeeding blood samples were collected 24 hours after overfeeding. In 2 sheep and 1 steer, the 24-hours blood samples were test positive. In 1 sheep which died, the 48-hour blood sample was the 1st test-positive sample. In all cases, pre-overfeeding blood samples were taken just before overfeeding.


Analysis of the effect of inapparent bovine paratuberculosis. Inapparent paratuberculosis was studied in a Guernsey herd with a history of paratuberculosis (Johne's disease); the herd was maintained at between 900 and 950 cattle. Fecal specimens and intestinal tissue specimens from any of these that were slaughtered were examined culturally for the presence  of Mycobacterium paratuberculosis. The reasons given for culling and slaughtering of cows from this herd were compared with infection status determined by culturing. Less than one-third of the culturally confirmed paratuberculous cattle were culled because of clinically apparent paratuberculosis. Mastitis was the reason for culling 3.6% of the non-infected cattle and 22.6% of the cattle with inapparent paratuberculosis. Infertility was also significantly higher in cows with inapparent paratuberculosis than in noninfected cows in the same herd. Separation of parturient dams and calves from the rest of the herd was shown to materially reduce the level of infection and incidence of clinical paratuberculosis.


Tarsal degenerative joint disease in cattle: blood and synovial fluid changes. Tarsal degenerative joint disease (DJD) in 27 cattle was classified as primary or secondary based on age, joint conformation defects, faulty hindlimb alignment, or history of trauma to the affected joint(s). Results of blood and synovial fluid analysis for cattle affected with primary or secondary tarsal DJD were grouped in compilation of data. Cattle with tarsal DJD had significantly (P smaller than 0.01) reduced hemoglobin (Hb) content in comparison to that in control cattle. There was highly significant (P smaller than 0.001) reduction in packed cell volume (PCV). A significant difference was not determined for mean corpuscular hemoglobin concentration (MCHC) values of the 2 groups of cattle. Total white blood cell (WBC) counts closely paralleled each other, although mean proportion of neutrophils was significantly (P smaller than 0.05) greater in cattle affected with tarsal DJD, as were mean proportion of lymphocytes (P smaller than 0.02). Synovial fluid samples were analyzed for physical, biochemical, and cytologic properties. Statistical comparisons were made between values determined for arthritic cattle and control cattle. All samples from cattle with tarsal DJD were transudative. Opacity and flocculation were attributed to the presence of cartilaginous fragments and fibrils. There was significant correlation between increased relative viscosity (RV) and higher grades of mucinous precipitate quality (MPQ; r = +0.294, P smaller than 0.05) for all cattle. Mean alkaline phosphatase (ALP) activity for arthritic cattle was significantly (P smaller than 0.001) reduced, as was the mean activity for lactic dehydrogenase (LDH; P smaller than 0.05). The mean aldolase (ALD) activity for arthritic cattle was increased, whereas mean activity values for glutamic oxalacetic transaminase (GOT) and glutamic pyruvic transaminase (GPT) were reduced. Samples from arthritic cattle had reduced total leukocyte counts and significantly (P smaller than 0.05) increased proportion of macrophages in comparison to the values in control cattle.


Endotoxin from Fusobacterium necrophorum of bovine hepatic abscess origin. The endotoxic activity of Fusobacterium necrophorum bov 5 was investigated. The supernatant (S) fluid and cell wall (CW) preparation, obtained after differential centrifugation of the ruptured cell mass, were lethal for mice. The toxicity of the S fluid was stable during prolonged storage, treatment with formalin, and heating for 15 minutes at 80, 100, and 121 C, but was destroyed by alkaline hydrolysis with 0.25 N NaOH. The toxic factor was found in a high molecular weight (MW) fraction after gel filtration. The properties exhibited by the toxic S fluid resembled those of endotoxic lipopolysaccharide (LPS). Extracted and partially purified LPS (endotoxin) from F necrophorum bov 5 demonstrated a mouse median lethal dose (mouse LD50) of 16.8 mg/kg of body weight. The toxic LPS material, a high molecular weight moiety as estimated by gel filtration, was resistant to ribonuclease (RNase), deoxyribonuclease (DNase), and pronase treatment. A positive Shwartzman reaction (median skin lesion dose (SLD50) equal to 3.32 mug/kg of body weight) and biphasic fever response (minimal dose required to produce a fever index of 40 sq cm which falls on the linear portion of dose-response curve (FL40) equal to 0.41 mug/kg of body weight) further indicated the toxin was endotoxin in nature. The LPS from F necrophorum bov 5 was less toxic than Salmonella typhimurium LPS; but had considerable toxicity for experimental animals. The toxic activity of the partially purified F necrophorum bov 5 endotoxin was separated into 2 fraction regions by diethylaminoethyl (DEAE)-cellulose chromatography. The data provide evidence for the production of a potent endotoxin, possibly composed of more than one toxic component, which may be released upon cell disruption.


Closure of ductus arteriosus determined by cardiac catheterization and angiography in newborn foals. The physiologic closure of the ductus areteriosus was determined in 4 foals less than 16 hours old. The common carotid artery was catheterized, using local anesthesia and tranquilization, and contrast medium was injected into the ascending aorta. Radiographs were made of heart and great vessels during and after the injection to visualize the pathway of injected contrast medium.


Influence of induced hypermagnesemia and hypocalcemia on neuromuscular blocking property of oxytetracycline in the horse. The neurally evoked contractile response of the upper lip muscles of horses anesthetized with halothane was used to evaluate the neuromuscular blocking property of oxytetracycline which was administered intravenously at total dose rate of 21 to 28 mg/kg. This dose rate did not alter the contractile response which had a mean control value (and standard error; SE) of 1.76 plus or minus 0.22 kg. Arterial blood pressure was not affected by these dose rates. Neuromuscular blocking effect of the antibiotic occurred when it was administered during partial neuromuscular blockade which had been induced by infusion of magnesium sulfate (0.12 or 0.16 g/kg). Moderate hypocalcemia induced by infusion of sodium oxalate did not enhance the neuromuscular blocking property of this antibiotic. Since the dose rates of the oxytetracycline preparation used had a small effect on calcium concentration of equine serum (smaller than 0.3 mg/dl), calcium binding does not seem to play a major role in the neuromuscular blocking effect of this antibiotic. It was concluded that the weak neuromuscular blocking effect of oxytetracycline is not a significant etiologic factor in the acute type of adverse reaction to this antibiotic that is occasionally encountered in horses.


Onchocerca cervicalis infection in horses from the western United States. In a study of Onchocerca cervicalis infection in a sample of 100 horses from the western United States, 48 were infected. Infection was more common in older horses and occurred in both sexes equally. Data about the distribution and the concentration of microfilariae within the skin are presented. The only cutaneous pathologic change that could be attributed to microfilariae was minimal perivascular inflammatory cell infiltrate. Invasion of the eye with microfilariae occurred in 60 percent of the infected horses. An attempt was not made to relate microfilarial invasion of the eye with ocular pathologic changes.


Ketamine-paraldehyde anesthesia for rabbits. Combination of ketamine hydrochloride (50 mg/kg) and paraldehyde (0.5 ml/kg), both administered intramuscularly, was found to be safe and effective for induction and maintenance of anesthesia for prolonged major surgical procedures in rabbits. Time of induction of deep surgical anesthesia was 20 to 30 minutes. Surgical procedures (creation of intestinal loops for perfusion studies) lasting 3 to 4 hours were performed, with an additional dose of ketamine (25 mg/kg) occasionally being given after 2 hours. At the end of the experiments, rabbits were killed. Another group of rabbits was maintained in a deep surgical plane of anesthesia for 5 hours without any surgical operation being done. Rabbits were then allowed to recover and, on the next day, were again anesthetized and allowed to recover without the performance of surgical operation. Finally, after a day's hiatus, the same rabbits were used in intestinal perfusion experiments. The use of 2 complementary anesthetics, each with a wide margin of safety for respiratory centers, provided safe anesthesia. The ability to administer a relatively fixed dose obviated the need for inordinate expertise to anesthetize rabbits for long periods.


Pattern of physiologic effects of adrenalectomy in the dog. Adrenalectomized dogs were observed in order to identify the patterns of physiologic changes occurring during development of adrenocortical insufficiency. Daily measurements included plasma concentrations of sodium and potassium, arterial blood pH, packed cell volume, heart rate, and selected components of the electrocardiogram (ECG). The pattern in which these measurements changed indicated that alterations in plasma concentrations of sodium and potassium, T-wave configuration, and QRS interval were more consistent, whereas alterations in P-wave configuration were not evident until approach of terminal stages.


Infectious bovine keratoconjunctivitis: a ring device designed for prolonged retention in the bovine eye. A study was conducted to determine whether treatment devices could be designed for prolonged retention in the eyes of cattle. Experimental design ring devices were compared relative to their ease of insertion, induction of adverse tissue reaction, and period of retention. The ring devices were also compared with commercially available devices used in human eyes. Ring devices having a circumference smaller than that of the conjunctival sac, but larger than that of the globe of the eye, were easy to insert, caused a minimal tissue reaction, and were retained by the eye up to 19 days. The authors suggest that a development using the ring design and an erodable matrix containing an antibacterial agent could lead to a possible method for the treatment of obstinate infections, such as infectious bovine keratoconjunctivitis (IBK) and Moraxella bovis carrier states in cattle.


Pathophysiologic features of Q fever-infected guinea pigs. Guinea pigs infected with 9-mile phase I strain of Coxiella burnetii had increased blood glucose concentrations; alkaline phosphatase (ALP), glutamic-oxalacetic transaminase (GOT), alpha-hydroxybutyrate dehydrogenase (alpha-HBDH), and creatine phosphokinase (CPK) activities; and bilirubin value. Hypocalcemia and hypophosphatemia were evident in the latter days of infection. At necropsy of the guinea pigs, necrotic foci were in liver, spleen, and heart. Seemingly, the major pathophysiologic changes in infected guinea pigs were the direct result of lesions in liver, spleen, and heart in which rickettsial bodies were readily observable with histologic staining procedures. The guinea pig may serve as an animal disease model for Q fever.


Development of a microculture system for stimulation of chicken peripheral blood lymphocytes with concanavalin A. A microculture system in conjunction with a semiautomatic multiple sample harvester (SAMSH) was used to study the in vitro properties of chicken peripheral lymphocytes. This new procedure enabled doing rapid multiple tests, using relatively few cells, and was highly reproducible. Data were presented to show many variables that are involved in studying the concanavalin A (Con A) response of chicken lymphocytes in a microculture system. Analysis indicated that the conditions for optimal Con A stimulation as measured by incorporation of 3H-TdR include: (a) use of 2 x 10(6) cells per culture in RPMI 1640 culture medium in the absence of any serum, (b) use of 0.4 mug of Con A per culture, (c) incubation at 37 degrees C for 72 hours, and (d) addition of 1 muCi of 3H-TdR to each culture 12 to 24 hours prior to termination. This technique could be used to monitor immunocompetence of the chicken.


Protein profiles of dense-centered forms of five chlamydial strains of animal origin. Purified dense-centered form of 1 bovine strain (LW613) and 3 ovine strains (B577, 034-EYE, and 047-EYE) of Chlamydia psittaci and 1 murine strain of Chlamydia trachomatis (MoPn) were dissociated in the presence of sodium dodecyl sulfate (SDS) and 2-mercaptoethanol. The number of polypeptides detected in the 5 strains varied between 17 and 20, with a molecular weight range of 29,000 to 120,000. Two polypeptides predominated and comprised approximately a third of the total protein in each of the 5 strains. The average molecular weights of the 2 polypeptides were 89,000 and 85,250 for 4 of the strains, and the polypeptide molecular weights were 100,000 and 98,000 for the ovine abortion strain (B577). Molecular weights and proportional composition of the polypeptides permitted differentiation of the chlamydial strains. The 3 strains from naturally occurring conjunctivitis or polyarthritis (LW613, 034-EYE, and 047-EYE) had similar polypeptide profile in the 75,000 to 100,000 molecular weight range. The polypeptides of the ovine abortion strain (B577) differed significantly from these 3 strains. Eight of the polypeptides of this strain had a molecular weight of 100,000 or greater, and 3 of the predominant polypeptides were in excess of 100,000. In contrast, some of the polypeptides of the murine strain had lower molecular weights than the 4 other strains. Three predominant polypeptides had molecular weights below 50,000.


Alterations of selected intestinal enzymes in hamsters with hamster enteritis syndrome. Portions of duodenum, jejunum, and ileum from 21 hamsters clinically affected with enteritis were examined for enzymes. Utilizing a variety of techniques, the activities of alkaline phosphatase, nonspecific esterases, leucine aminopeptidase, beta-glucuronidase, and methyl green pyroninophilia were determined. The activities of enzymes normally associated with tissue proliferation and active protein synthesis were decreased, whereas those enzymes associated by cytolysis were increased.


Cultivation of mycoplasma from conjunctiva and production of corneal immune response in guinea pigs. Mycoplasma canis was the most frequent mycoplasmal isolant obtained from the conjunctival surface of the eyes of dogs. Nine mycoplasmal isolates, 5 were M canis, were recovered from the lower cul-de-sac of 101 dogs. Experimentally induced immune keratitis was produced by sensitizing guinea pigs to 3 antigen preparations of M canis and then administering intracorneal challenge inoculation. The guinea pigs were clinically observed by leukocyte migration-inhibition (LMI) technique and by histopathologic study of their corneas. The corneal reaction of the guinea pigs was not identical to a clinical entity of the dog.


Excretion of carbon-14-labeled aflatoxin B1 via bile, urine, and intestinal contents of the chicken. Carbon-14-labeled aflatoxin B1 was prepared by growing Aspergillus parasiticus in medium containing sucrose-14-C as the sole carbon source. The 14-C-labeled aflatoxin B1 was extracted with chloroform and purified by thin-layer chromatography (TLC) followed by precipitation from solution and washing. The 14-C-labeled aflatoxin B1 was intravenously given to anesthetized dwarf White Leghorn or Rhode Island Red hens with cannulated ureters and bile ducts. The 14-C had a calculated plasma half-life of 1.5 minutes and rapidly appeared in the bile. The 14-C concentration in the bile reached values approximately 7 times maximum for plasma, and most could no longer be extracted with chloroform. This finding indicated that metabolites of the 14-C-labeled aflatoxin B1 had been excreted against a concentration gradient into the bile. The quantities of 14-C excreted via bile, urine, and intestinal contents remained at a fairly constant ratio of 70:15:15, respectively, over the 315-minute experimental period. Six major chloroform-soluble compounds containing 14-C were isolated. Three of these were tentatively identified as aflatoxin B1, B2, and M1. A 4th was believed to be aflatoxin B2a. None of the early chloroform-soluble metabolites were as cytotoxic as aflatoxin B1.


Elimination of sulfamethazine from edible tissues, blood, urine, and feces of turkey poults. Sulfamethazine was administered to 8- to 10-week-old turkey poults intravenously (IV) at the dose level of 71.5 mg/kg of body weight, orally at the dose level of 143 mg/kg of body weight, or in the drinking water at the concentration of 0.1% over a 6-day period. The concentrations of free sulfamethazine in blood, muscle, skin, kidney, and liver were determined and semilogarithmic plots of concentration vs time for the various tissues indicated that the curve had a linear portion within the first 72-hour period of drug withdrawal. The rates of disappearance of sulfamethazine from the various tissues were proportional to the concentration in the tissues. After 72 hours of withdrawal and for as long as 14 days, sulfamethazine concentrations in kidney, liver, and skin of turkeys given the drug in the drinking water fluctuated between 0.1 and 0.4 ppm. Only 8.6% of the oral dose (143 mg/kg) and 16.5 to 17% of the IV dose (71.5 mg/kg) were recovered in urine and feces as the parent compound during the initial 72-hour period.


Method of collecting urine and comparative investigation of quantities excreted by cats and dogs after administration of furosemide. A method is described for precise investigation of diuresis and saluresis in cats, using trained animals in a special diuresis apparatus. Furosemide given intramuscularly (IM) to cats at the dose level of 10 mg/kg produced slight untoward reactions of short duration. Therefore, this dose lies at the upper limit of tolerance. Saluretic and diuretic effect of 5 different doses of furosemide was investigated in 4 cats and 20 dogs. A dose-dependent increase in diuresis was achieved in cats given doses of furosemide ranging from 1.25 to 10 mg/kg. In the dog, the range of effectiveness was broader. In both species, there was a parallel increase in the excretion of sodium and chloride ions. The excretion of potassium ions in the cat remained unaffected, whereas in the dog, there was a dose-dependent increase in potassium ion excretion, which became especially distinct when large doses were given. A direct comparison of total saluretic and diuretic values in the dog and cat after IM administration of furosemide was not possible, since the calculated straight lines had different slopes, and their points of intersection lay outside the scope of this study. A difference can be assumed to exist between dog and cat in the mode of action of diuresis and saluresis after administration of furosemide.


Frequency of second-degree atrioventricular heart blocks in dogs. Clinically normal adult dogs and pups 8 to 24 weeks of age were monitored for 2nd-degree atrioventricular (AV) heart block. Radiotelemetry was used to obtain the electrocardiogram (ECG) of resting, unanesthetized, unrestrained dogs. Second-degree AV heart block was detected in 64% of 11 adult dogs and 100% of 12 pups between 8 and 11 weeks of age. The dropped beats, prolonged P-R intervals, and prolonged P-P intervals appeared to be associated with the respiratory cycle. Atropine quickly reduced the frequence of dropped beats. It was concluded that occasional dropped ventricular beats due to 2nd-degree AV heart block may be normal in dogs, especially young dogs.


Cardiopulmonary effects of xylazine in dogs. Effects of the drug xylazine were determined on arterial pH, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), aortic blood pressure, aortic flow, heart rate, pulse pressure, stroke volume, and peripheral resistance of dogs. The drug was given intravenously (IV) with and without atropine and was given intramuscularly (IM) without atropine. After IV administration of xylazine (1.1 mg/kg), arterial pH, PaO2, and PaCO2 values were not changed from control values. However, the drug did produce a statistically significant decrease in heart rate, decrease in aortic flow, initial increase in blood pressure followed by decrease, and increase in peripheral resistance. Stroke volume and pulse pressure were not significantly changed. Atropine (0.02 mg/kg, IV) did not significantly change any of the effects produced by xylazine. Intramuscular administration of xylazine (2.2 mg/kg) did not produce significant changes in arterial pH, PaO2, or PaCO2. Heart rate and aortic flow decreased significantly, but statistically significant changes did not occur in aortic blood pressure or peripheral resistance; however, the changes in these last 2 values were in the same direction and were of similar magnitude as those which occurred afger IV administration of xylazine.


Transmission of Ehrlichia canis to dogs by ticks (Rhipicephalus sanguineus). Two strains of Rhipicephalus sanguineus acquired Ehrlichia canis by feeding as either larvae or nymphs on acutely infected dogs and, in subsequent instars, transmitted the agent to normal dogs. Three strains of R sanguineus transmitted E canis as adults after their larval and nymphal stages fed on infected dogs. More than 400 adult female ticks were fed on infected dogs as larvae or nymphs or both, but none transmitted E canis transovarially.


Nitrite and nitrate pharmacokinetics in the dog, sheep, and pony. Elimination kinetics of nitrite and nitrate in the dog, sheep, and pony were determined. The elimination half-lives of nitrite were 0.499, 0.475, and 0.566 hours in the dog, sheep, and pony, respectively; those of nitrate were 44.681, 4.233, and 4.821 hours. Apparent specific volumes of distribution (V'd) of nitrite were variable among the 3 species--1,623.7 ml/kg in the dog, 278.0 ml/kg in the sheep, and 191.6 ml/kg in the pony. The V'd of nitrate were less varied--dog, 238.5 ml/kg; sheep, 291.1 ml/kg; and pony, 209.3 ml/kg. In the in vitro studies on protein binding in canine plasma, the extent of nitrite-protein binding varied directly with concentrations of 5 to 25 mug of NO2 minus/ml (4.5 to 13.6% bound), but inversely with concentrations of 50 to 100 mug of NO2 minus/ml (9.8 to 8.8% bound). Less than 1% of nitrate was bound to canine plasma at equimolar concentrations (5 to 100 mug of NO3 minus/ml).


Certain features of erythrocytes of normal and glutathione-deficient sheep. Studies were made of certain characters of erythrocytes of normal and glutathione (GSH)-deficient sheep. The results indicate that erythrocytes of GSH-deficient sheep are no more sensitive to oxidative damage than those of normal sheep.


Joint changes in lameness of confined swine. Hampshire swine reared in confinement developed spontaneous lameness. In a comparison of lame swine with normal Hampshire and normal Yorkshire swine, there were no substantial differences in the gross or microscopic appearance of synovial membranes or volume of synovia per joint. Somatic cell count in synovia of lame Hampshires was higher than that of normal Hampshires; however, in normal Yorkshires, cell count was higher than that of either group of Hampshires. Total protein and total lactic dehydrogenase (LDH) values were significantly higher in synovia of lame swine than in synovia of normal swine, as were also the gamma-globulin and LDH5 values. Hampshire swine seemed to be more heavily muscled than the Yorkshires, but the difference was not significant. In a 2nd comparison, joints of the swine were regrouped as normal or abnormal, on the basis of macroscopic appearance. Significant differences were not detected in total volume of fluid per joint, number of somatic cells per milliliter of fluid, total protein, or the 3 microscopic lesion scores in this comparison. Total LDH was significantly higher in the abnormal joints.


Swine dysentery: pathogenicity of Treponema hyodysenteriae. When pure cultures of Treponema hyodysenteriae were orally inoculated into pigs, severe disease characteristic of swine dysentery developed. Less severe lesions were produced by oral inoculation of infective minced colon. Noninoculated pigs were used as controls. Inoculations of surgically isolated porcine colonic loops with either pure cultures or infective minced colon produced lesions only in the injected loop; the adjacent noninjected colon remained normal. Pigs and other experimental animals, including rabbits, guinea pigs, and mice, inoculated with washed cultures by various parenteral routes remained normal.


Scanning electron, light, and transmission electron microscopy of intestine of gnotobiotic calf. Adjacent areas of upper, middle, and lower parts of the small intestine and spiral colon from a 48-hour-old gnotobiotic calf were compared by scanning electron microscopy (SEM), light microscopy (LM), and transmission electron microscopy (TEM). As visualized by all 3 methods, small intestinal histologic features, except for apical location of villous epithelial cell nuclei in sections of upper and middle parts of small intestine, were similar to those described for other species. The colonic surface visualized by SEM was composed of flattened ridges separated by furrows into which opened the crypts of Lieberkühn. The epithelial surfaces of the ridges and the furrows had an extensive microvillous covering and scattered goblet cell openings.


Primary pulmonary sporotrichosis complicated by perirectal abscess. A 48-year old, retired mounted policeman was followed for 4 years through 4 hospitalizations for progression of his bilateral, cavitary lung disease. His sputum was always negative for acid-fast bacilli and fungi. Subsequently, a painful perianal swelling appeared that was incised and drained of purulent material. Five years after first seen, sputum and rectal drainage revealed Sporothrichum schenckii in many cultures. Serologic evidence of sporotrichosis was also present. With amphotericin B therapy, the patient showed marked clinical improvement. Unfortunately, he died from an episode of acute respiratory failure. Although most patients with primary cutaneous or primary pulmonary sporotrichosis are horticulturists, the writers believe that this disease should be considered in any undiagnosed, chronic, cavitary lung disease, even in the absence of this occupational history.


The tuberculin tine and Mono-Vacc tests in the patient with active tuberculosis. Eighty-four patients with culture-positive Mycobacterium tuberculosis infections of the lung were evaluated with the Mono-Vacc and tine tuberculin skin tests. A previous report indicated that false negative reactions with the tine may occur in up to 6 per cent of patients when it is used as a screening device for tuberculin sensitivity. However, as indicated by this study, it is unlikely that either screening tests would miss active tuberculous infection; no false negatives occurred in the 84 patients.


Bronchial dimensions and stature.

Bronchial dimensions and stature. The summed cross-sectional area of the right main and left main bronchi was found to be directly related (r=plus0.54) to body length in 64 necropsies, and the best relation was to the square of the body length. These data, in conjunction with previously published information, indicate that tall subjects have larger lungs having the same number of main bronchi and small airways that are larger than those of short subjects. Tall subjects have more alveoli than short subjects, but it is not known what differences in alveolar size exist.


Stability of amphotericin B in polyvinvl chloride intravenous infusion bags. The stability of solutions of amphotericin B as prepared for intravenous use in glass and polyvinyl chloride plastic (PVC) containers was studied. Four conditions were tested: contained within glass and exposed to light; contained in glass and shielded from light; contained in PVC and exposed to light; contained in PVC and shielded from light. Bioassays were performed on specimens collected from the containers periodically during 24 hours. Results of the bioassays revealed no significant loss of activity under any of the test conditions.


Occult pulmonary hemorrhage in anticoagulated patients. Evidence for severe intrapulmonary bleeding was obtained in 3 anticoagulated patients who presented with pulmonary infiltrates. The diagnosis of pulmonary hemorrhage was based on findings of markedly elevated quantities of stainable hemosiderin and hemoglobin in alveolar macrophages retrieved by bronchopulmonary lavage. In 2 of the patients, roentgenographic abnormalities regressed after anticoagulation was reversed. The third patient died and massive bilateral pulmonary hemorrhage was found at autopsy. The syndrome of occult pulmonary hemorrhage was characterized clinically by dyspnea, unexplained acute anemia, and infiltrates with an alveolar pattern on chest roentgenogram. Hemoptysis was conspicuously absent. Bronchopulmonary lavage and quantification of alveolar macrophage hemosiderin content may be useful in identifying intrapulmonary bleeding occurring in an otherwise occult manner. Recognition of pulmonary hemorrage in anticoagulated patients is important because reversal of anticoagulation can be life saving.


Response to chemotherapy of pulmonary infection due to Mycobacterium kansasii. Chemotherapy of pulmonary disease due to Mycobacterium kansaii has not always been successful, and resectional surgery has been used frequently in the treatment of this infection. To ascertain the impact of new antimicrobial agents on the treatment of M. kansaii infection, we reviewed the clinical courses of 59 patients treated between 1971 and 1974. Over-all, 92 per cent of patients converted their sputum cultures while receiving drugs, with only one patient undergoing surgical resection. Regimens containing rifampin were universally effective in both initial and retreatment cases; however, they offered no significant advantage over monrifampin regimens in initial treatment cases. In vitro resistance to isoniazid and ethambutol did not adversely affect the results of treatment with these drugs. Owing to the effectiveness of current chemotherapy, parameters such as age, underlying lung disease, or extent of disease were not related to the outcome of therapy. Because 90 per cent of the conversions in successful regimens occur within 4 to 6 months of beginning therapy, patients whose cultures remain positive should be considered for alternate drugs. Because the frequency of relapse after current chemotherapy is not yet clear, and because rifampin appears to be particularly advantageous in retreatment programs, rifampin should be reserved for this role. The total course of treatment should probably span at least 18 months, or 6 months beyond any cultural or radiographic evidence of activity.


Lidocaine blood concentrations during fiberoptic bronchoscopy. Blood lidocaine concentrations were measured in 21 patients during routine fiberoptic bronchoscopy. In one patient, concentrations were in the toxic range. Measureable, but generally safe, concentrations were observed in the remaining patients. Cardiac and central nervous system toxicity may result from lidocaine adsorption, particularly in the seriously ill patient, although none was observed during the course of these studies.


Fever and pneumonia after flexible fiberoptic bronchoscopy. The frequencies of fever, parenchymal infiltration, and bacteremia were studied prospectively after 100 flexible fiberoptic bronchoscopies performed transnasally under topical anesthesia. Fever occurred after 16 per cent, and parenchymal infiltration, after 6 per cent of the procedures. Most complications were mild and transient; however, one patient developed rapidly progressive pneumonia and died. No organisms were isolated from cultures of blood drawn at the time of the procedure or during complications. The organisms most commonly isolated from the sputum of the patients who developed pneumonia were the aerobic and anaerobic bacteria normally found in the mouth. Isolation of a significant pathogen before the procedure did not predispose to development of a complication. Advanced age (greater than 60 years) and the endoscopic findings of abnormalities were significant predisposing factors. Bronchial brushing, but not bronchial biopsy or bronchial washing, was associated with significantly higher complication rates in patients with bronchial carcinomas than in those without a neoplasm. The mechanism of the fever and parenchymal infiltration is thought to be related to obstructive atelectasis and infection produced by organisms present in the airways at the time of the procedures.


Goblet cells in the peripheral airways in chronic bronchitis. It was not possible to demonstrate an increase in the proportion of goblet cells in the bronchioles of patients with chronic bronchitis and no emphysema, whereas other lesions, such as mucous gland hyperplasia, airway narrowing, and airway mucus were easily demonstrated in similar cases. Thus, it seems that goblet cell metaplasia is not an important factor in patients who have chronic bronchitis but little evidence of chronic airflow obstruction. Goblet cell metaplasia is an obvious feature of patients with chronic bronchitis and emphysema, especially in those with symptomatic or fatal chronic airflow obstruction, and it may be responsible for producing obstruction in the peripheral airways of these subjects. The role of goblet cell metaplasia in smokers with little airflow obstruction is uncertain from the data presented. No difference was noted in the proportion of goblet cells between bronchitic patients and nonbronchitic smokers who did not have clinical airflow obstruction.


Adrenocortical and somatotrophic secretions in acute and chronic respiratory insufficiency. Adrenocortical function and plasma growth hormone pattern were investigated in 15 patients with chronic obstructive lung disease, in a period of acute respiratory failure and again after recovery. During the acute period, secretion rate and plasma concentrations of cortisol were markedly enhanced; urinary excretion of cortisol metabolites was only slightly increased, suggesting an alteration of the catabolism of cortisol under these conditions; adrenocortical sensitivity to corticotropin and capacity of maximal adrenal secretion were normal. The increase of cortisol secretion was probably due to hypoxemia and/or hypercapnia acting through the hypothalamo-pituitary axis. During the chronic phase of respiratory insufficiency, adrenocortical secretion and responsiveness were within the normal range. Finally, respiratory failure did not stimulate the secretion of growth hormone.


Effect of elevated triglycerides on the diffusing capacity of man. In view of the decreased diffusing capacity recently reported in man during lipid infusion, studies have now been made on the effects of hyperlipidemia on the diffusing capacity for carbon monoxide (DLco). In normal volunteers and patients with hyperlipidemias, DLco and plasma triglyceride concentrations were determined during fat tolerance tests and while the patients were on diets that increased or decreased triglyceride concentrations. During the fat tolerance tests, the largest triglyceride and DLco changes were from 346 mg per 100 ml with a DLco of 18.8 ml per min per mm Hg to 1,545 mg per 100 ml with a DLco of 23.4 ml per min per mm Hg. While patients were on speical diets, the largest triglyceride and DLco changes were from 5,102 mg per 100 ml and 29.0 ml per min per mm Hg to 492 mg per 100 ml and 26.4 ml per min per mm Hg, respectively. Sta tistical tests showed no significant change of DLco with change in triglyceride concentration. The data suggest that there is normally no association between change in triglyceride concentration and change in DLco, and that triglycerides normally transported in plasma, even when present in extreme amounts as chylomicrons or very-low-density lipoprotein, do not affect the DLco.